<!-- Side Navigation starts --> 
<div class="span3">

    <div class="well sidebar-nav">
        <ul class="nav nav-list">
            <li class="nav-header">List Menus</li>
            <li><a href="<?php echo $this->Html->url(array('controller' => 'Dashboard', 'action' => 'index')); ?>"><i class="icon-white icon-home"></i> My Dashboard</a></li>
            <li class="active"><a href="<?php echo $this->Html->url(array('controller' => 'Dashboard', 'action' => 'enter')); ?>"><i class="icon-book"></i> Enter Loading Data</a></li>
            <li><a href="#"><i class="icon-check"></i> Save Loading Data</a></li>
            <li><a href="<?php echo $this->Html->url(array('controller' => 'Dashboard', 'action' => 'edit')); ?>"><i class="icon-pencil"></i> Edit Loading Data</a></li>
            <li><a href="<?php echo $this->Html->url(array('controller' => 'Dashboard', 'action' => 'view')); ?>"><i class="icon-th-list"></i> View Loading Data</a></li>
            <li class="nav-header">Another list Menus</li>
            <li><a href="#"><i class="icon-align-right"></i> Export Data</a></li>
            <li><a href="#"><i class="icon-list"></i> Sort and Export Data</a></li>
            <li class="divider"></li>
            <li><a href="#"><i class="icon-flag"></i> Help</a></li>
        </ul>
    </div>

    <!--/.well -->
</div>
<!-- Side Navigation ends -->  <!--/span-->
<div class="span9">

    <div class="form-actions" style="margin-top: 0px; font-weight: bold">
        Daily Data Upload
    </div>
    
    <div class="bs-docs-example">

    <form class="form-horizontal" method="post" id="form" action="<?php echo $this->Html->url(array('controller' => 'MemberSite', 'action' => 'become_member')); ?>">
        <fieldset>


            <div class="control-group">
                <label class="control-label " for="fname">* Company Name</label>
                <div class="controls">
                    <input type="text" name="fname" required pattern="[a-zA-Z0-9]+"  class="input-xlarge capitalize" id="fname" value="" />
                </div>
            </div>

            <div class="control-group">
                <label class="control-label" for="mname">* Truck Number</label>
                <div class="controls">
                    <input type="text" name="mname" required="" class="input-xlarge capitalize" id="mname" value="" />
                </div>
            </div>

            <div class="control-group">
                <label class="control-label" for="email">* Quantity</label>
                <div class="controls">
                    <input class="input-xlarge" required name="email" id="email" type="email" value="" />

                </div>
            </div>
            <div class="control-group">
                <label class="control-label" for="content">Other Information</label>
                <div class="controls">
                    <textarea class="input-xlarge" required id="content" name="content" rows="3"></textarea>
                </div>
            </div>

            <div class="control-group">
                <label class="control-label"  for="mobile_phone">* Way Bill Number</label>
                <div class="controls">
                    <input type="text" name="mobile_phone" class="input-medium" id="mobile_phone" required pattern="[0-9-\s]{6,20}" value="" />
                </div>
            </div>

            <div class="control-group">
                <label class="control-label">Send Information to OMC:</label>
                <div class="controls">
                    <label class="checkbox" for="offer_by_email">
                        <input type="checkbox" id="offers_by_email" name="offers_by_email" checked="" /> &nbsp; By Email
                    </label>

                    <label class="checkbox" for="offer_by_phone">
                        <input type="checkbox" id="offers_by_phone" name="offers_by_phone" checked="" /> &nbsp;  By SMS
                    </label>
                </div>
            </div>

            <div class="form-actions">
                <button type="submit" class="btn btn-success" id="submit_btn"><i class="icon-forward icon-white"></i> Save Data</button>
                <a href="<?php echo $this->Html->url(array('controller' => 'Dashboard', 'action' => 'enter')); ?>" class="btn" id="cancel_btn"><i class="icon-backward"></i> Back</a>
            </div>
        </fieldset>
    </form>
</div><!--/span-->
